Preserving the Nipple Projection in Breast Reduction with the Free Nipple-Areolar Graft Technique: Purse-String Suture

Breast reduction with the free nipple-areolar graft (FNG) technique has disadvantages such as loss of nipple projection, loss of nipple sensation, and depigmentation of the nipple-areolar complex. In this study, patients in whom a purse-string (PS) suture was used in the center of the de-epithelialized area to prevent loss of nipple projection were compared with patients who underwent the conventional method. A retrospective analysis of the patients who underwent breast reduction with the FNG was conducted in our department. Patients were divided into two groups according to the FNG placement. In the PS suture method group, a 1-cm-diameter circumferential suture was placed with a 5-0 Monocryl® (poliglecaprone 25) suture to gain a 6-mm-nipple projection. In the conventional method group, the FNG was placed directly over the de-epithelized area. Graft viability was evaluated after 3 weeks postoperatively. The final nipple projection and depigmentation were evaluated after 6 months postoperatively. The results were evaluated with statistical tests. The number of patients with the conventional method was 10, and the PS suture method was 12. There was no statistically significant difference between two groups regarding graft loss and depigmentation (p > 0.05). Nipple projection was significantly higher in the PS method group (p < 0.05). We observed that PS circumferential suture made an acceptable nipple projection compared to the conventional method in breast reduction with the FNG technique. Since the method is easy to apply and has relatively low risk, it would contribute to clinical practice. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .